Compassion is at the heart of nursing, but not all nurses can turn that compassion inwards. Yet there has never been a more vital time to practice self-compassion. We are in unprecedented times and the high pressure that nurses work under has increased substantially due to the COVID-19 pandemic. Many nurses may feel too overstretched to even contemplate taking time for themselves, but now is the perfect time to do just that. Let’s start by examining how self-compassionate you are and how you might be able to enhance your self-compassion.
What is self-compassion?
Self-compassion refers to the process of turning compassion inwards and being kind to yourself while still be able to acknowledge your humanity, imperfection and fragility.1 Kate Upton, a Registered Adult Nurse and Fellow of the Higher Education Academy, expands on this definition by explaining that, ‘Self-compassion is a construct that plays a significant role in how people deal with life’s difficulties. It can be beneficial for the caregiver, with corresponding benefits for the individual needing care.’
The core components of self-compassion in nursing are best represented in Kristin Neff’s Model of Self-Compassion.2 Neff describes self-compassion as being made up of three parts:
Mindfulness (versus over-identification) ‘Mindfulness facilitates awareness of our moment-to-moment experience, including thoughts, feelings and emotions, as well as other people and the world around us,’ says Dr Caroline Barratt, a Lecturer at the University of Essex. ‘To be self-compassionate, we need to be aware of our current state of mind and be honest with ourselves about that.’
Self-kindness (versus self-critical judgement) ‘Self-kindness is learning to react to our experiences with kindness,’ adds Dr Barratt. ‘It might be as simple saying something soothing to ourselves, doing something that we enjoy, or allowing the experience to be there without judgement.’
Common humanity (versus isolation) Dr Barratt describes common humanity as ‘when we acknowledge that we are not alone in our experience of suffering. Our particular circumstances may be unique, but everyone faces difficulties in their lives.’
An important question is why so many nurses may have trouble with self-compassion. ‘Self-compassion is often misunderstood and may be viewed as self-indulgent,’ suggests Dr Barratt. ‘Self-compassion is not selfish; it is a basic act of care that we often reserve for others. Self-compassion is a way of conceptualising how we might treat ourselves with positive regard. It is not about seeing ourselves as more important than anyone else.’
Why is self-compassion so important for nurses?
Self-compassion is, of course, important for everyone. However, those in compassionate roles are at greater risk of compassion fatigue if they don’t turn their compassion inwards. It can also mean they miss out on the benefits of self-compassion.
Describing self-compassion as a ‘sensory, embodied process,’ Dr Barratt explains that being kind to the self allows nurses to better identify what is good for them and to trust their instincts about what they need at a given time.
According to Dr Mark Durkin, a researcher from the Faculty of Health and Well-being at the University of Bolton, ‘Evidence suggests that self-compassion can improve empathy, pro-social behaviours, and how one relates to others. It has also been shown to help protect nurses from compassion fatigue and manage the stress associated with their work.’ Ultimately, increasing compassion for oneself and others can decrease stress, improve staff well-being and patient care, and also maintain organisational commitment and life satisfaction.3 Emotional intelligence and effective coping strategies are also vital benefits that emerge from self-compassion
It has even been suggested that compassionate care is not possible without self-compassion.4 Dr Hannah Andrews, an assistant professor in Nursing at Coventry University and clinical nurse specialist for the NHS, echoes this sentiment, especially around the humanity aspect of self-compassion. ‘Acknowledging humanity is key, as nurses are often viewed as automatons, moving very quickly from one task to the next without feeling or emotion,’she says. Consequently, recognition of humanity and the need to focus care inwards are essential outcomes of providing compassion to others.
Detrimental effects of poor self-compassion
‘If nurses are unable to recognise the importance of (or apply) self-compassion, they may be unable to recognise when they are struggling, when they need to attend to their own needs, and when they are becoming fatigued,’ says Dr Andrews. Indeed, there is a correlation between low self-compassion and the presence of compassion fatigue in acute medical care hospital nurses.3
‘Prolonged, continuous and intense contact with patients can sometimes overwhelm the psychological resilience of a nurse, leading to a point where the compassionate energy used by the nurse exceeds their restorative processes,’ explains Dr Durkin. ‘Subsequently, recovery power is lost, and compassion fatigue ensues.’
Dr Durkin’s research reveals that weak self-compassion could result in Secondary Traumatic Stress (STS), which can lead to anxiety, intrusive thoughts, sleep disturbances, and increased blood pressure.3
In the absence of self-compassion and its components of mindfulness, self-kindness, and common humanity, nurses may adopt ineffective coping strategies to self-manage their compassion fatigue or STS, such as withdrawal, emotional numbing, and avoidance. Such coping strategies can result in adverse workforce outcomes, such as:
- More sick days
- Higher staff turnover
- Patient dissatisfaction
- Increased nursing mistakes
Consequently, weak self-compassion and the resultant compassion fatigue can affect nurses on both a professional and personal level.3
How can nurses become more self-compassionate?
According to Upton, ‘For a nurse to develop genuine compassion towards others they need to be able to connect with their own feelings and behaviours so they can take care of their own well-being whilst providing care for others.’ Dr Andrews adds, ‘It’s all about balance and recognising the need that to care for others, there is also a need to care for the self.’
Importantly, nurses will need to understand that being self-compassionate can feel difficult at first. However, utilising techniques such as mindfulness can help strengthen the process.5 Dr Durkin describes a wide range of free practical tools on the websites of Kristin Neff and Professor Paul Gilbert that are available to nurses wishing to develop their self-compassion.
Seven exercises to help you develop self-compassion include:6
How would I treat a friend in this situation? Answering this question encourages you to think about how things might change if you responded to yourself in the same way you would typically respond to a close friend.
Take a self-compassion break Taking a break to focus on self-care helps you remember to evoke the three aspects of self-compassion at the moment you need it most.
Explore self-compassion through writing From a place of kindness and care, write a letter to yourself about an aspect of yourself that you don’t like.
Seek a supportive touch Get a massage or hug someone you care about. This teaches you how to activate your parasympathetic nervous system via touch to help you feel calm, cared for, and safe.
Change your critical self-talk Reframe your self-critical voice to be more friendly. This will become a kinder blueprint for how you treat yourself.
Start a self-compassion journal Make self-kindness, common humanity, and mindfulness part of your daily life by writing self-compassionately about difficult events.
Identify what you really want By focusing on what you want rather than what you don’t want, your inner dialogue becomes more positive and you start to feel better about yourself.
Upton suggests ‘self-briefing’ and ‘self-reflection’ as coping strategies to help nurses rationalise their feelings and put their emotions into perspective. She also suggests implementing targeted support programmes, such as Mindfulness-Based Stress Reduction and Compassion Circles, as well as providing regular debriefing sessions to encourage nurses to talk openly about their emotional experiences. There are five pathways nurses can follow to develop self-compassion (Table 1).5
Self-compassion does not begin and end with the nurse
If nurses are to be fully present, connected, and compassionate with their patients, the environments they work in must encourage self-compassion and prioritise the well-being of nurses. Healthcare organisations and managers need to adopt the behaviours and attitudes necessary to provide its nursing workforce with the opportunities they require to effectively develop self-compassion. This will benefit nurses, patients, and organisations.
Nicola Davies is a freelance medical writer
References
1. Andrews H, Tierney S, Seers K. Needing permission: The experience of self-care and self-compassion in nursing: A constructivist grounded theory study. Int J Nurs Stud. 2020 Jan 1;101:103436.
2. Neff K. Self-compassion: An alternative conceptualisation of a healthy attitude toward oneself. Self Identity. 2003 Apr 1;2(2):85-101.
3. Durkin M, Beaumont E, Hollins Martin CJ, Carson J. A pilot study exploring the relationship between self-compassion, self-judgement, self-kindness, compassion, professional quality of life and well-being among UK community nurses. Nurs Educ Today. 2016 Aug 46;DOI:10.1016/j.nedt.2016.08.030.
4. Duarte J, Pinto-Gouveia J, Cruz B. Relationships between nurses’ empathy, self-compassion and dimensions of professional quality of life: A cross-sectional study. Int J Nurs Stud. 2016 Feb 26;60:1-11.
5. Barratt C. Exploring how mindfulness and self-compassion can enhance compassionate care. Nurs Stand. 2017 Jan 18;31(21).
6. Self-Compassion Dr. Kristin Neff [Internet]. Austin: Center for Mindful Self-Compassion; c2020 [cited 2020 Apr 14]. Self-Compassion Guided Meditations and Exercises; [about 2 screens]. Available from: https://self-compassion.org/category/exercises/#ex...